INTRODUCTION

We live in our world today where everything seems to be in a fast face.

As it is, we cannot deny that things change over or in a certain period of time. New technologies were being
invented, clothes for fashion, jewelries, luxuries mode of entertainment, etc. It ’s just like having a new mode of
socialization, cultures, beliefs, perceptions, adaptation to life and environment. With all of these, one aspect of human
being which are greatly affected and the one which we have to be most concern of would be in the side of our heath and
well being.

In the Philippines there are many diseases illness arising because of environmental changes that may be caused
by human activities and geographical conditions. It is considered as one of the tropical country and so disease can spread
through out the country.

One example of these is disease is what we called Dengue Fever and dengue Hemorrhagic Fever (DHF). It is
considered as one of the acute febrile diseases caused by one of the four closely related virus serotype of the genus
flavivirus. It can be transmitted by Aedes Aegypti mosquito to humans usually attacking during the day. One will
experience onset of fever, severe headaches, muscle and joint pains which will give name to Breakbone Fever or
Bonecrusher. There are also rashes characterized by bright red petechaie commonly seen on the lowers limbs and on the
chest. There may also be gastritis associated to abdominal pain, nausea, vomiting, or diarrhea. Proper attention of health
care provider should be given including good assessment, early detection or diagnosis and medications which are
essential for total interference of prevention.
GOAL:
General Goal:
 To be knowledgeable about the nature of Dengue Fever Syndrome, management and treatment to be able
to render effective nursing care to the client.

Specific Goal:

 To be familiar with the etiology of the disease

 To know the pathophysiology of the disease
 To be aware of the signs and symptoms
 To know its complications
 To be knowledgeable on how to prevent the disease
 To know the treatment and how to apply it
 To know the diagnostic exam
 PATIENT’ S PROFILE

Name:X
Age: 13 years old
Gender: Male
Address: # 32 Natividad St. Malanday San Mateo, Rizal
Date of Birth: October 24, 1995
Place of Birth: Marikina
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Occupation: N/A
Date of Admission: November 11,2019
Time of admission: 9:00 pm
Physician: Dra. Del Valle
Place of Admission: H-Vill Hospital
Admitting Diagnosis: Dengue Fever Syndrome

a.1 CHIEF COMPLAIN

 The patient complains of abdominal pain, headache, fever and general flushing of skin with on and off vomiting.
a.2 PRESENT ILLNESS
 Four days prior to admission, the patient had an intermittent fever associated with abdominal pain, headache, and
general flushing of the skin with on and off vomiting. A few hours prior to admission still the above sign and
symptoms remain but already have (-) vomiting with accompanying chills and was diagnosed with Dengue fever
Syndrome.

a.3 PAST MEDICAL YEARS

 It was according to the patient that he wasn't been hospitalized yet not until when he was diagnosed with Dengue
Fever Syndrome. Before that diagnosis, he was already experiencing fever and his mom gives him a Paracetamol
for remedy.

a.4 FAMILY HISTORY

 According to his grandmother the only disease that the family has genetically is Diabetes Mellitus and no other
diseases noted.

a.5 SOCIAL HISTORY

  CJS is the son of Mr. and Mrs. SJ. CJS is currently on the secondary level of education at Roosevelt College at
Malanday, Marikina City, near their place.
 His father works as a seaman while his mother is a housewife; his grandmother is also living with them. Hence, his
grandmother and his mother were the ones responsible in all the household chores.

According to CJS, he eats vegetables and fish instead he prefers eating hotdogs. Furthermore he has no other
vices except for computer games. After school hours, he goes directly to the computer shop together with his
brother and friends.

a.6 ENVIRONMENTAL HISTORY

 According to the patient the environment that the family have has an open drainage, wherein big rats and
cockroaches can be seen. The house is cleaned by his mother and grandmother. It was described by the patient
that there are parts of their house that is deprived from light.


C. HISTORY OF ILLNESS
 During the mid of August, CJS, started experiencing fever that persist only at night. As a remedy his mom gave him
Paracetamol to lower his body temperature. Except from fever he ’s also experiencing abdominal pain, headache
and general flushing of the skin with on and off vomiting.
 As the above signs and symptoms persists, his parent decided to bring him to the hospital.

Upon the physical assessment and after several diagnostic procedures that the patient had undergone, he was
diagnosed with Dengue Fever Syndrome (DFS) and was admitted under the service of Dra. Del Valle.

THEORETICAL FRAMEWORK

CJS, is at the stage of puberty, was diagnosed of having Dengue Fever Syndrome (DFS).At the clinical check-up,
the physician was able to identify some clinical signs of it and was referred to Dra. Del Valle. The case of CJS can be
correlated with the theory of Florence Nightingale

Application Theory:

The case of CJS can be correlated with the theory of Nightingale wherein, the environment of the patient is a factor
leading to recovery. Having a clean, well ventilated and quite environment is important in. With a nurturing environment,
the body could repair itself.
PHYSICAL EXAMINATION

PHYSICAL ASSESSMENT

1. Received Patient on bed awake conscious and coherent

2. With IVF D5LR 1000ml at 450 cc level and regulated at 25gtts/min.

I. LINEAR MEASUREMENT

1. Height: 5’4’’
2. Weight : 51kgs.

PHYSICAL ASSESSMENT
NAME: X
DATE OF ASSESSMENT: November 11,2019
VITAL SIGNS:
BP: 10070 mmHg PR: 76bpm
RR: 22bpm Temp: 36.5˚C

General Appearance: Received lying on bed, conscious and coherent. Pale and has general flushing with rashes
Area assessed Technique
Used
Normal Findings Actual Findings Rationale

Area Assessed Method Used Normal Findings Actual Findings Rationale

SKIN
Color and Inspection Light to deep brown General flushing Decrease WBC
pigmentation in the body

Lesions Inspection No lesions, scars or inflammation No lesions, but Normal

Texture Palpation Smooth presence of scars Normal
Moisture Palpation Moist Smooth Normal
Temperature Palpation The skin springs back to its previous Moist Normal
Mobility and turgor Palpation state after being pinched The skin springs Normal
back
to its previous state
after being pinched
NAILS
Nail bed color Inspection Pink Pale Decrease RBC
Shape Inspection Convex Convex in the body
Lesions Inspection No inflammation of No inflammation of Normal
Thickness Palpation the skin around the nail the Normal
capillary refill Palpation Firm skin around the nail Normal
Firm Normal
Normal capillary (less than 3secs)
refill

HEAD
Size Inspection Proportion to the body Proportion to the Normal
Symmetry Inspection and the skull is body Normal
 rounded and smooth and the skull is
Symmetrical rounded
and smooth
HAIR Symmetrical Normal
Color Inspection Black No nits/lice present Normal
Texture Inspection Curly hair, straight Normal
Other findings Inspection No nits/lice present

SCALP
Distribution of hair Inspection Evenly distributed No inflammation, Normal
Lesions Inspection No inflammation, lumps Normal
Other findings Inspection lumps or masses or masses Normal

FACE
Skin color Inspection Light to deep brown Pinkish Due to fever
Texture Inspection Smooth Symmetric facial Normal
Facial movement Inspection Symmetric facial Symmetric facial Normal
movement movement

EYES
External structure Inspection Evenly distributed
Eyebrows Inspection Evenly distributed, Pink conjunctiva Normal
Eyelashes Inspection Evenly distributed, curved outward Evenly distributed Normal
Eyelids Inspection Evenly distributed Normal

EARS Same as facial color Symmetric to head

Color Inspection Symmetrical at the No discharges and
Symmetry Inspection level of the eyes inflammation Normal
Shape and size Inspection corner Normal Normal
Symmetric to head Normal
No discharges and
inflammation
Same as facial color

NOSE Same with facial color Same with facial

Color Inspection Symmetric color
Shape Inspection No discharges Symmetric Normal
Discharges Inspection No discharges Normal
Normal

MOUTH Symmetric
Lips Inspection Pink Symmetric
Symmetry Inspection Moist Pink Normal
Moisture Inspection Dry Normal
D/t poor
TONGUE Positioned at the nutrition
Position Inspection center can move Central position
Color Inspection freely Dull red Normal
Texture Inspection Dull red Smooth Normal
Mobility Inspection Smooth Can move freely Normal
Lesions Inspection Can move freely No lesions or Normal
No lesions or inflammation Normal
inflammation

NECK Head centered

Position Inspection Symmetrical Head centered
Symmetry Inspection Smooth movements Symmetrical Normal
Range of movements Inspection without discomfort Smooth Normal
Palpation Symmetric and at movements Normal
midline position without discomfort Normal
Symmetric and at
midline position

UPPER AND LOWER

EXTREMITIES Equal size
Size Inspection Symmetrical
Symmetry Inspection Evenly distributed Equal size Normal
Distribution of hair Inspection Light to deep brown Symmetrical Normal
Skin color Inspection No lesions, Evenly distributed Normal
Lesions Inspection deformities or Light to deep brown Normal
inflammation No lesions, Due to
deformities or disease
Temperature Inspection Normal inflammation

Normal Normal
 GORDON’ S 11 FUNCTIONAL HEALTH PATTERN

BEFORE DURING INTERPRETATION

FUNCTION HOSPITALIZATION HOSPITALIZATION
Nutrition  Eats 3x a day  Mostly eat bread  The Doctor ordered
 He loves to eat bread DAT diet to the patient
& processed foods except dark colored
such as hotdog, food
tocino, longanisa, and
others.
 He doesn’t eat
vegetables and fish
 Seldom drinks water

 This time he
frequently drinks  To replace fluid loss
water
Elimination  He is able to urinate  He can still urinate  His condition doesn’t
& defecate normally & defecate by affected his elimination
everyday by himself himself even without pattern
 He doesn’t have any an assistance
problem on his
elimination
 Defecates usually
early in the morning
before going to
school
Sleeping  Has a regular  Disturbed sleeping  Due to adherence to
sleeping pattern pattern time of medication &
 Normal sleep is 6-8 vital signs monitoring
hrs. per day but he
naps for 1-2 hrs in the
afternoon
Cognitive-  Has a normal  He is responsive &  Portraying
Perceptual cognitive perception can communicate cooperativeness
Pattern  Can comprehend well well
 He responds
appropriately to
verbal & physical
stimuli
Self-  Perceived himself as  This time he  Due to his ability to
Perception- a good friend, brother perceives himself as establish good rapport
Self & son. an approachable to other people
concept person
 Role  He was able to do his  This time his role as  Due to his condition,
Relationshi responsibilities as a a patient is not fully he is not aware of
p Pattern son & brother met performing his real role
in this field.
Sexuality-  He doesn’t think of  Same  Due to his youthful
Reproductiv the things like having mind, it is still not his
e Pattern a girlfriend & getting priority in life
married.
Coping  He doesn’t fully  Same  At his age, he still has
Stress & identifies his a playful mind & he
Tolerance stressors. doesn’t mind the
Pattern stressors in life.
Activity-  His daily routine on  He interacts with his  He only focuses on
Exercise playing computer. His grandmother & simple things.
Pattern daily activities were other people around
limited in waking up him
in the morning to  Cooperates well to
attend his class & the doctor & nurses.
after that going to
computer shop.
Value-Belief  He is a Catholic  Due to their culture
Pattern preferences & parent’s
influence

Health Perception –  He perceived  He thinks that  Due to his illness

Health Management his health in the he is not
Pattern state of good healthy
condition

HEMATOLOGY

EXAMINATION REFERENCE EXAM INTERPRETATION

VALUE RESULTS
Aug. 24,2009 Aug. 26, 2009
RBC COUNT 4-6X10 / L
12
5.1 4.7 Within normal range
WBC COUNT 5-10X10g/L 3.0 2.4
HEMOGLOBIN Male: 140- 155 138 Within normal range
170gms/ L
Female: 120-
140gms/L
HEMATOCRIT Male:0.43- 0.47 0.42 Within normal range
0.54
Female:
0.37-0.45
DIFFERENTIAL
COUNT
SEGMENTERS 0.55-0.65 0.57 0.40
LYMPHOCYTES 0.25-0.35 0.43 0.60
MONOCYTES 0.02-0.06 -----------
EOSINOPHIL 0.01-0.03 -----------
BASOPHIL 0.01-1.0 -----------
CLOTTING TIME ----------- -----------
BLEEDING TIME ----------- -----------
BLOOD TYPE ----------- -----------
ESR ----------- -----------
STAB ----------- -----------
PLATELETS 150-400x103 172 166 Within normal range
g/L
 Brand name/ Classification Action Indication Adverse Effect Contraindication Nursing
Generic name consideration
Acetaminophen Nonopoiod Produce Symptomatic Rash, nausea, Hypersensitivity. Patients with
(Paracetamol) analgesics and analgesia relief of pain and vomiting, blood Patients alcoholic liver
anti pyretics by blocking fever. Relief of dyscrasias , disease.
pain headache, anemia, analgesic Impaired liver
impulses by toothachge, back nephropathy , or kidney
inhibitinfg pain, nephrotoxicity , function
synthesis of dysmenorrheal, hypersensitivity
prostaglandi myalgias,neuralg reactions
n in the ias, etc.
CNS or of Analgesics and
other anti pyretic for
substances patients
that hypersensitive to
sensitize aspirin
pain
receptors to
stimulation.
 Assessment Nursing Diagnosis Planning Nursing Rationale Evaluation
Intervention
Subjective: Risk for impaired Short Term Goal: Independent After 8 hours of
“Nangangati ako” as skin integrity related Nursing Action: rendering effective
verbalized by the to Within 2hours of -Monitor vital signs - Serves as baseline nursing intervention
patient nursing intervention, data to determine the goal was
patient will any discrepancies completely met as
Objective: demonstrate - Provide skin -To maintain skin evidenced by
V/S taken: Aug behavior in hygiene through integrity at optimal patient’s
24,2009 as of 4pm preventing skin sponge bathing & level. demonstration of
impairment. changing regularly behavior in
BP – 100/70mmHg preventing skin
Temp. – 36.5˚C Long Term Goal: - Keep bed clothes -To avoid lesions, impairment.
RR – 22 bpm dry, use non- scratching of skin & -patient verbalizes
PR – 76bpm After period of irritating materials, & harboring of comfortability,
hospitalization, the keep bed wrinkled microorganism. decrease feeling of
- Redness of the patient will be able free itchiness and
skin to understand and gradual
- Skin rashes apply treatment/ or - Palpate skin - To assess extent of disappearance of
therapy, regimen to lesions for size, involvement of skin rashes.
the skin impairment. shape, consistency, impairment. -patient’s skin
texture & hydration color(pigmentation)
becomes normal
- Encourage -To prevent friction (absence of
reposition schedule that may cause redness)
for client irritation of the skin

-Provide information - To promote

to the client about wellness by gaining
the importance of knowledge on
regular observation treatment/ therapy
& effective skin care
 Assessment Nursing Diagnosis Planning Nursing Rationale Evaluation
Intervention
Subjective: Acute pain related to Short Term Goal: Independent After 8 hours of
“Masakit ang tiyan clinical Nursing Action: rendering effective
ko” as verbalized by manifestations of Within 8 hours of -Perform a - To improve quality, nursing intervention
the patient. dengue hemorrhagic effective nursing comprehensive frequency & location the goal was
fever intervention patient assessment of pain of pain. partially met as
will be able to feel evidenced by less
Objective: less pain on his - Provide -To alleviate pain. guarding of stomach
V/S taken: Aug abdomen. nonpharmacologic and patient’s
24,2009 as of 4pm management like verbalize partial
change of position & relieve of pain.
BP – 110/70mmHg Long Term Goal: applying warm
Temp. – 35.5˚C compress
RR – 30bpm After period of - Encourage divers -To divert his
PR – 67bpm hospitalization, the ional activities attentions to the
patient will be able - Encourage rest pain
- Guarding of to maintain a relax period - To prevent fatigue
stomach and calm abdomen.
- Facial grimace
- Pain scale of 8 Dependent nursing
intervention:
- Administer - To alleviate pain.
medications as
order by physicians
such s gastroflora
 Assessment Nursing Diagnosis Planning Nursing Rationale Evaluation
Intervention
Subjective: Elevated body Short Term Goal: Independent After 8 hours of
“Mainit po ang temperature related Nursing Action: rendering effective
katawan ko”as to Within 8 hours of -Monitor vital sign - Serves at baseline nursing intervention
verbalized by the effective nursing data. the goal was
patient. intervention patient - Monitor intake and -To know the fluid completely met as
body temperature output balance of the body evidenced by
will be decrease patient’s body
from 38.6- 37.5˚C - Perform TSB - To reduce body temperature
Objective: temperature through decreases from
V/S taken: Aug the process of 38.6-37.5˚C.
25,2009 as of 6pm Long Term Goal: conduction Patient’s skin not
-Increase oral fluid - To prevent warm to touch.
BP – 110/70mmHg After period of intake dehydration and Normal complexion
Temp. – 38.6˚C hospitalization, the support circulating of the skin.
RR – 30bpm patient will be able volume.
PR – 67bpm to know the proper - Provide safe & - To provide
management of quite environment conducive place to
- Flushing of skin hyperthermia rest .Inform the
- Skin warm to touch -Inform the patient patient about proper
about proper management of
management of fever
fever - To be able for the
patient to know the
Dependent nursing proper
intervention: management.
- Administer
medications as
order by physicians -To elevate the
such as patient’s body
Paracetamol or any temperature.
anti –pyretic drugs.
 PHATOPHYSIOLOGY
↓
Bite of a aedes aegypti mosquito carrying a virus
↓
Virus goes into the circulation
↓
Infects cells & generate cellular response
↓
Initiates destruction of the platelet
↓
↑ Potential for hemorrhage
↓
Stimulates intense inflammatory response
▼ ▼
Release of exogenous pyrogens The body releases anti-
↓ inflammatory mediators
↑ WBC (Neutrophils & Macrophages) (Histatin, Kinins)
↓ ↓
Release of endogenous pyrogens Vascular response
↓ ↓
Reset of hypothalamic thermostat Redness & Heat
↓ ↓
Fever Headache, Vomiting
▼ ▼ Epistaxis, Abdominal pain
Muscle contract Blood vessels Circulatory Collapse Shock
To produce construct to ↓
Additional heat prevent loss of body heat DEATH
↓ ↓
SHIVERING CHILLS

Discharge Planning

A. Patient's Name:
> C.J.S a thirteen year-old male patient, who was diagnosed with Dengue
Hemorrhagic Fever.
B. Diet:
> Encourage nutritious foods like vegetables, meat and fruits.

C. Medications:
> Give acetaminophen in case the temperatures increases.
> Give oresol to replace fluid in the body.

D. Treatment:
> Increased oral fluid intake.

E. Health Teaching:
> D- discuss the possible source of infection of the disease.
> E- educate the family/patient on how to eliminate those vectors.
> N- Never stocked water in a container without cover.
> G- Gallon, container and tires must have proper way of disposal.
> U- Use insecticides at home to kill or reduce mosquito.
> E- Encourage the family of the patient to clean the surroundings to destroy the
breeding places of mosquito.